Individual
JOHN JACOB SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2121 E DUPONT RD STE C, FORT WAYNE, IN 46825-1546
(260) 490-2013
(260) 490-1081
Mailing address
2121 E DUPONT RD STE C, FORT WAYNE, IN 46825-1546
(260) 490-2013
(260) 490-1081
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12009584
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000214282
BLUE CROSS BLUE SHIELD
—
01
—
190009098
RAILROAD MEDICARE
—
05
—
200169990A
—
IN
Enumeration date
07/17/2006
Last updated
01/27/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us